Medicaid coverage, methadone maintenance, and felony arrests: outcomes of opiate treatment in two states

Abstract

A modest number of clinics in Oregon and Washington provide MMT maintenance treatment (MMT) services. More than 10,000 clients in each state were followed for 3 years after an initial admission for opiate use between 1993 and 2000. Medicaid clients in both states had far greater access to MMT than their non-Medicaid counterparts, controlling for differences in client characteristics using propensity scores. Months in MMT were associated with much lower arrest rates than time not in treatment, but unexpectedly this was only true for clients participating in MMT for many months. Despite differences in the treatment systems for opiate addiction in these two states observed in previous studies, the current findings generalized across both states.

Figure 1

Predicted probability of methadone enrollment for Oregon clients during months Medicaid eligible (solid line) or not eligible (dashed line) for clients with high (blue lines) or low (red lines) proportion of months Medicaid eligible. Utilization is much higher in months of Medicaid eligibility as long as there is stable eligibility. However, low propensity clients are unlikely to get methadone regardless of Medicaid eligibility.

Figure 2

Predicted probability of a felony arrest in Oregon during months in methadone maintenance treatment (MMT, solid lines) compared to months untreated (dashed lines) by prior arrest history (red lines) or no history (blue lines). Arrests are much less likely as long as there is stable methadone enrollment.

Figure 3

Predicted probability of a felony arrest in Washington during months in methadone maintenance treatment (MMT, solid line) compared to months untreated (dashed line) for clients with a prior arrest history (red lines) or no history (blue lines). As with Oregon, arrests are much less likely when enrolled in MMT as long as there is stable enrollment over time.